Sustainability for 39 Months....A CLABSI Free Intensive Care Unit

Purpose:
The objective or focus of our project was to prevent or eliminate hospital associated Central line blood stream infection(CLABSIs).

Significance:
An estimated 41,000 central line associated bloodstream infections occur in U.S. hospitals each year. The two clabs reported in the Cardiothoracic ICU in 2007 and the one clab reported in early 2008 stimulated this group to review literature and current best practices, and our journey to zero began.

Strategy and Implementation:
The objective or focus of our initiative was to eliminate hospital associated CLABSIs in the Cardiothoracic Intensive Care. The use of all inclusive premade supply kits for insertion of central lines was being utilized in our institution at the time of our initiative. A procedural bundle for safe insertion was already in place. A newly introduced directive surrounding central line necessity, evaluation and tracking was simplified through the use of the EHR. Leadership engaged critical care staff to evaluate and remove high risk lines before transferring patients to the general nursing unit. However, One of the major changes in practice that was implemented in the CT-ICU specifically was the use of the product Chlorahexadine Gluconate (CHG) on all levels of patient care. The decision to remove all patient cleansing products used in the ICU was made. CHG liquid skin cleanser and CHG wipes were added to the stock to replace the items. The trial was initiated on February 16,2010.

Evaluation:
The Cardiothoracic Intensive care achieved 39 months with out a CLABSI.

Implications for Practice:
This successful initiative and exemplary outcome was shared with the 20 hospitals across our organization at the collaborative Infection Control Practitioner meeting. Also, the use of CHG has recently been implemented as a standard of care in the UPMC Shadyside's five Critical Care areas.